.Grand Jury Report Scrutinizes Behavioral Health Division

A Santa Cruz County Grand Jury report determined that the Behavioral Health Division struggles to meet the county’s mental health needs, and has neither the fiscal means nor staff resources to do the job.

Investigators also found severe gaps in addressing healthcare needs in South County.

In response, Health Services Agency Departmental Communications Officer Sandra Hughes pointed out a few missing items from the report.

She said the division provides community-based services to approximately 7,000 people annually. This, in turn, reduces or eliminates healthcare costs for patients, and 60% of the client base resides in South County, Hughes says.

Initially, the Grand Jury decided to look into the budget of the Health Services Agency, but found that the behavioral division had the most significant single budget because it provides services to address mental health, substance use and other public health programs, therefore making it the main focus of the investigation.

Within the same report, they found that the staff vacancy rate was 30%.

The organization struggled to find bilingual psychiatrists, psychiatric nurses and licensed mental health practitioners. Based on this year’s interviewees, finding adequate staff still needs to be solved.

Hughes pointed out that the behavioral health employee shortage challenge is a nationwide challenge.

“A recent survey in March 2024 indicated that the vast majority of BHD staff were satisfied with their jobs (66%) and were likely to remain in the BHD in the next five years (60%), and the overall survey response rate was 48%,” she said.

Another part of the report—the External Quality Review—showed that Santa Cruz County has three times the number of high-cost beneficiaries (HCB) compared to the state average for 2018 through 2020. HCBs are individuals with approved claims of more than $30,000 a year.

None of the officials interviewed could answer why Santa Cruz County was ranked higher than other counties within the state for having many high-cost beneficiary patients, and no data was provided to the Grand Jury for HCBs by zip code.

According to the Grand Jury report, the health agency data collection needed to comply with mandatory county and state requirements does not measure the outcome.

For example, the data collected may reflect the number of people a program serves. This, however, does not include the number of rehospitalizations or improvements in industry-approved scores. The Grand Jury also looked into the number of people transferred to out-of-county hospitals, which occurs when the county can’t provide a bed or offer available treatment services.

Along with these challenges, the department lacks the funding to provide the services the county needs.

However, Hughes argued that the Grand Jury report contains many erroneous statements.

“The reported numbers include out-of-county transfers from hospitals, which include physical health and emergency department transfers,” she says. “This approach exponentially inflates the problem.”

Hughes added that the numbers in the Grand Jury report lists are transfers from full-service hospitals, not psychiatric hospitals/facilities.

“This is irrelevant to Behavioral Health/Psychiatry,” she says.

Hughes also says that the upcoming Youth Crisis Stabilization Center and Youth Crisis Residential Program will add capacity and reduce the instances of children being transferred out of the county.

The statistics all point to a disturbing reality: Santa Cruz County, compared to other counties in California, is struggling to provide mental health services to a large, high-need population that the County can’t correctly handle because of a lack of resources.

While the Grand Jury had a lot of critiques about the behavioral health division, the report offered some recommendations to make the program more approachable to those in need. 

This includes enhancing the effort put into case management to help reduce long-term healthcare costs, reducing the amount of out-of-county transfers by investing in local resources, addressing socioeconomic disparities in South County to improve health outcomes, and a transparency overhaul of the program outcomes and costs.

To see the report, visit bit.ly/3VLHcrk.


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